Oscar M. Guillamondegui

Salivary epithelial-myoepithelial carcinomas of intercalated ducts: A clinical, electron microscopic, and immunocytochemical study☆

The salivary epithelial-myoepithelial carcinoma of intercalated duct origin is a distinctive, biologically low-grade carcinoma with a predilection for the parotid gland. Nine examples from the M.D. Anderson Hospital in Houston, Texas, bring the number of published cases to 33. Immunocytochemical (S-100 protein, myosin, and keratin) and electron-optic studies strongly support an active myoepithelial cell participation in the histogenesis of these carcinomas.

Postoperative irradiation in malignant epithelial tumors of the parotid

From 1954 through 1979, 77 patients with malignant tumors of the parotid gland were referred from the Department of Head and Neck Surgery for postoperative irradiation. The analysis has been made by grouping the patients according to the estimated amount of disease left after the surgical procedure and by the histological types. There were no local failures in the low-grade tumors, and there were 6 in the 63 patients with high-grade tumors. With gross residual disease or potential residual disease the patients received slightly higher doses than those without. Although there were only 6 failures in the various histological types, there was perhaps a trend to more failures in the adenocarcinomas. There was no difference in the failure rates in patients having had a total resection of the facial nerve or partial resection or no resection. The preferred treatment has been a combination of 20 MeV photons and 18 MeV electrons. Five neck failures were essentially a result of lack of elective irradiation of the neck. Severe complications appeared only in the patients irradiated either for gross residual disease or excision of a recurrence with a high risk of widespread microscopic residual disease.

Combination chemotherapy of head and neck cancer.

A total of 77 patients with cancer of the head and neck area were treated with five different drug combination regimens. Five of the 77 patients had lymphoepithelioma; four had adenocystic carcinoma, and 68 had squamous‐cell carcinoma of the head and neck (16 from the skin). Of these 77 patients, 16 had no previous treatment, five had surgery, 11 had radiotherapy, and 45 had surgery and radiotherapy. The first regimen consisted of a four‐day Bleomycin infusion followed after a 24‐hour rest, by cyclophosphamide (Cytoxan), Vincristine (Oncovin), methotrexate and 5‐Fluorouracil (5‐FU) (B‐COMF). The next three regimens consisted of a four‐day Bleomycin course, followed by either Cytoxan and methotrexate (B‐CM), Cytoxan and 5‐FU (B‐CF) or Methotrexate and 5‐FU (B‐MF). The fifth regimen consisted of Bleomycin concomitant with Cytoxan, Methotrexate, and 5‐FU (B‐CMF). Of the 49 patients receiving B‐COMF and B‐CMF, 12 showed a complete response and 12 a partial response. Among the 28 patients receiving Bleomycin, followed by any one of the two drug regimens, only six showed a partial response. The severity of the thrombocytopenia, number of drugs, lymphoepithelioma histology and performance status of the patient influenced the rate of response. Drug toxicity consisted mostly in myelosuppression. The B‐CMF combination is highly effective and can be used as an adjuvant to surgery and/or radiotherapy. Cancer 42:1661–1669, 1978.

Intravenous hyperalimentation in patients with head and neck cancer.

Intravenous hyperalimentation was utilized to support nutritionally 23 malnourished patients with major head and neck tumors during surgical treatment, radiotherapy, or the convalescent period. Fifteen patients were treated during the perioperative period and 12 survived. Six patients received convalescent nutritional support successfully 4 to 24 months following operation or radiation treatment. Two patients received treatment with hyperalimentation throughout a protracted course of radiation therapy. Weight gain, wound healing, and recovery were achieved in all but 3 patients. Subclavian vein thrombosis occurred in 1 patient, and catheter‐related sepsis occurred in 2 patients. Otherwise, hyperalimentation was safe and efficacious in the debilitated patients. These patients may now become acceptable risks for surgical treatment or radiation therapy by nutritional repletion with intravenous hyperalimentation.

The immune restorative effect of cimetidine administration in vivo on the local graft-versus-host reaction of cancer patients

The immunorestorative effect of cimetidine in vivo on T-cell-induced local graft-versus-host (GVH) reaction was analyzed in 29 cancer patients. Twenty patients received 1200 mg/day cimetidine orally for 7 days and nine patients remained untreated for the same period of time. Local GVH reaction was assessed before and after the 7-day treatment (or no treatment). A significant augmentation of the local GVH reaction was observed among cimetidine-treated patients 32.6 ± 21.2 mm3 before cimetidine versus 49.7 ± 46.1 mm3 after cimetidine (P 0.5). Seven of sixteen cimetidine-treated patients who were initially characterized by a negative ( 50 mm3), compared with none of eight initially local GVH reaction negative among the untreated controls. The absence of changes among the controls suggests that the local GVH reaction status is a relatively stable function not subject to substantial diurnal variation. Four cancer patients in the treatment group were initially GVH reaction positive. Three of those remained so or showed a slight augmentation after 7 days of treatment, but in one patient, cimetidine was detrimental. These results confirm our previous in vitro studies with cimetidine and lend further support to the use of this drug as an immunomodulating therapy in cancer patients.

Mucinous adenocarcinomas of nose and paranasal sinuses

This study concerns the Clinicopathologic findings for 18 patients with mucinous adenocarcinomas of nose and/or paranasal sinuses. Males in the 5th decade of life predominated in the series. Nasal obstruction, a growing mass in a sinus, or epistaxis were the most frequent complaints. Ten patients had tumors in the maxillary antrum, and the nasal cavity was the site in 5 patients. Histopathologically, the tumors were papillary or solid. The majority of the papillary tumors were moderately to well differentiated, with a few poorly differentiated types. Tumors with the solid pattern of growth were anaplastic; these patients had poorer prognoses. For most patients, treatment consisted of radical surgery alone or in combination with radiotherapy. Of 13 patients for whom survival could be adequately evaluated, 7 died from the tumors, 5 are alive and free of disease more than 4 years, and 1 is living with recurrent tumor 14 months after diagnosis.

Continuous cisplatin (24‐hour) and 5‐fluorouracil (120‐hour) infusion in recurrent head and neck squamous cell carcinoma

Cisplatin and 5‐fluorouracil (5‐FU) has been reported to be one of the most active chemotherapeutic regimens in recurrent head and neck squamous cell carcinoma. In this study, 21 patients with recurrent head and neck squamous cell carcinoma received a combination of cisplatin given as a 100 mg/m2 continous infusion over 24 hours and 5‐FU given as a 1000 mg/m2 24‐hour continuous infusion for 120 hours. Toxicity was evaluated in all patients, and response and survival were evaluated 20 patients. There were two complete remissions (10%) and three partial remissions (15%) for a major response of 25%. Overall survival for the complete responders was 79+ and 61+ weeks, respectively. Median survival for all patients was 36 weeks. Toxicity consisted of moderate to severe nausea and vomiting in 14 patients (66%), mucositis in 14 patients (66%), granulocytopenia of less than 1000/μl in 11 patients (52%), objective peripheral neuropathy in one patient (4.7%), and nephrotoxocity in one patient (4.7%). We conclude that the efficacy of 24‐hour cisplatin infusion and 120‐hour 5‐FU infusion in the treatment of recurrent head and neck squamous carcinoma is not superior to the efficacy of single agent trials reported in the literature.

Clinical staging system for cancer of the salivary gland: a retrospective study.

A comprehensive retrospective study of 861 patients with cancer of the salivary glands from 12 U. S. and Canadian participating institutions was carried out, and a TNM classification system is proposed for the staging of salivary gland cancer. This involves use of five clinical variables: size and local extension of the primary tumor, palpability and suspicion of the regional lymph nodes, and the presence or absence of distant metastases. We recommend its use for the staging of this cancer.

Salivary gland cancers of the palate

Abstract A relatively good prognosis can be expected in patients with salivary gland cancers of the palate after surgical resection alone. Antral salivary gland cancers have a worse prognosis than corresponding cancers of the palate but a better prognosis than squamous cell carcinoma in this area. At this time, we believe that postoperative radiation therapy for cancers of the palate is mandatory for patients with stage T 3 and T 4 lesions, grade III histologic classification, large nerve or blood vessel invasion, cervical node metastasis, multiple adverse microscopic criteria, or positive surgical margins. Microinvasion of small nerves is not a useful criterion in selecting patients for postoperative radiation therapy.

The place of irradiation in the treatment of malignant tumors of the salivary glands

1. Radiation therapy is not indicated after surgical removal with adequate margins of low-grade tumor. 2. Radiation therapy is indicated with a) Inadequate surgical margins in low-grade tumors b) All high-grade tumors c) All recurrent malignant tumors 3. Irradiation of nerve pathways is indicated with demonstrated nerve and perineural invasion and/or with adenoicystic carcinoma. 4. Irradiation of the entire ipsilateral neck is indicated a) Wtih high-grade tumors unless radical neck dissection shows negative nodes b) In the place of radical neck dissection.